Anxiety is an emotional reaction that occurs in response to a threat or to fear. Anxiety commonly results in feelings of nervousness, apprehension, restlessness and internal shakiness (the “butterflies”). Anxiety can cause worrying, poor concentration, tension, difficulty making decisions and sleep problems. Physical signs of anxiety include an uneasy stomach, diarrhea, frequent urination, headache and shakiness.

There are two types of anxiety common to heart patients. Generalized Anxiety Disorder is when a person tends to worry a lot about things that have happened or that could happen. When a heart patient has had a heart attack or cardiac surgery — two highly significant events posing threat and fear — having some anxiety about what has happened and the effect it will have on the future is expected.

Anxiety becomes problematic when a patient (or family member) continues to worry excessively about their health, becomes convinced another serious medical event is going to occur and is overly concerned that every twinge or bodily sensation means something bad is happening. Patients with generalized anxiety disorder are typically unable to accept reassurance from the cardiologist that their worries are unwarranted and that their symptoms don’t pose a health threat.

With a normal anxiety response to a frightening cardiac event, anxiety symptoms will improve as the patient is able to reassure oneself that their health is on the mend. Patients with ongoing anxiety tend to go to their doctors more often, have more medical procedures, ask a lot of questions but are not satisfied with the answers and are more reluctant to get on with life.

Another type of anxiety is Panic Disorder. Panic tends to come on quickly without warning and has many of the same symptoms as a heart attack — chest pain, heart palpitations, clamminess or sweating, shortness of breath, fatigue, dizziness, fear of dying and feelings of tingling or numbness. People who have panic disorder but not heart disease are often seen in the emergency room or doctor’s office because they think they are having a heart attack. Cardiac patients who have had a heart attack often think it’s happening again, not realizing they have an anxiety disorder, too. A vicious cycle can develop in either situation causing frustration for both the patient and the medical professionals.

Any symptoms of heart disease or heart attack should always be evaluated by a cardiologist first. If cardiac problems are ruled out, then psychological intervention is warranted. Psychotherapy and, if necessary, medication are very effective treatments for generalized anxiety disorder and panic disorder. Untreated anxiety can contribute to heart disease and interfere with recovery because it heightens the tendency to focus on physical symptoms and decreases focus on heart healthy changes.

Determining whether anxiety is occurring along with heart disease and getting it treated early is critical to long-term survival. Take this quiz and if anxiety is identified, get treatment now — your life depends on it!

Go to Anxiety Risk Assessment